Effect of renal function on whole blood and fibrin clot formation in atrial fibrillation patients on warfarin

Objective: Atrial fibrillation (AF) brings a risk of thrombosis, requiring oral coagulation, and is associated with renal impairment. The two processes may be linked, as altered fibrin clot structure is present in end-stage renal failure. We hypothesised that progressively deteriorating renal function is linked to altered whole blood and fibrin clot properties and fibrinolysis. Methods: Thrombogenesis and fibrinolysis in 200 warfarinised AF patients was assessed by thromboelastography (TEG), a micro-plate assay (MPA) and the international normalized ratio (INR). Renal function was determined by creatinine clearance and two versions of the estimated glomerular filtration rate (eGFR). Results: Two TEG indices independently reflecting thrombogenesis were linked to creatinine clearance (p?p?p?p?p?=?0.001). The INR was unrelated to any renal function index, and the CHA₂DS₂VASc score was unrelated to any index. Conclusion: In warfarinised AF patients, renal function is linked to whole blood clot and fibrin clot formation, structure and dissolution, but has no effect on the INR.

• Key messages

• Despite oral anticoagulation, patients with atrial fibrillation (AF) still suffer from stroke and venous thromboembolism.

• The effect of renal function in warfarinised patients with AF is unknown and may account for excess thrombosis and/or haemorrhage.

• Using two different laboratory methods, our data point to an effect of renal function on clot structure and function that is independent of an effect of warfarin.

     

下肢深静脉血栓形成患者抗凝蛋白缺陷的临床研究

目的：研究中国人群下肢深静脉血栓形成（IDVT）患者抗凝蛋白缺陷的发生率，探讨中国人群LDVT的主要发病机制。方法：应用ACLPutLlm型全自动血凝仪检测1幔）例LDVT患者（73例初发，27例复发）和100例健康人的抗凝血酶（AT）、蛋白S（PS）、蛋白C（PC）活性及活化蛋白C抵抗性（APCR）。结果：LDVT组与正常对照组相比、LDVT复发组与初发组相比，AT、PS、PC活性明显降低，APCR阳性率明显升高，均有极显著差异（P〈0．01）；本组100例LDVT患者中共有25例患者存在有抗凝蛋白缺陷，以PS缺陷的总发生率最高，为13％（13例），其次是PC缺陷，为8％（8例）；AT缺陷占5％（5例），APCR缺陷的总发生率最小，为4％（4例）。结论：先天性或获得性抗凝蛋白缺陷是中国人LDVT发病和复发的重要机制之一，因此有必要对LDVT患者进行抗凝蛋白水平的筛选。     

对应用浅静脉留置针老年患者心理护理和系统健康教育的效果研究

目的探讨和研究心理护理和系统健康教育在老年患者浅静脉留置针的应用效果。方法对200例应用浅静脉留置针的住院老年患者,随机分为观察组和对照组,每组患者100例,对照组采用普通常规健康教育方法,观察组患者在此基础上给予心理护理和系统的健康教育。结果两组患者评价指标结果比较和并发症情况比较,经χ2检验,P<0.01,有显著差异。结论实施心理护理和系统健康教育可明显提高老年患者治疗依从性、留置针相关知识水平、对护理工作满意度和自护能力,延长静脉留置时间,降低并发症的发生率,增加患者舒适度,减轻痛苦,获得了良好的护理效果。     

护理干预预防重症产妇剖宫产术后下肢深静脉血栓形成的临床价值

目的探讨护理干预对重症产妇剖宫产术后下肢深静脉血栓形成的预防作用。方法选择184例重症剖宫产术后患者为研究对象,随机分为2组,观察组（98例）术后启动血栓高危因素评价表,术后第一天开始每天行运动锻炼及下肢行空气压力循环治疗,2次／天,30min／次。对照组（86例）给予常规护理。术后第1天、第7天行彩色多普勒超声检查双下肢深静脉血流情况及每天测量大腿、小腿周径,比较两组患者下肢深静脉血栓的发生率及下肢肿胀发生率。结果下肢深静脉血栓对照组6例、观察组0例,两组比较差异有统计学意义（χ2=5．031,P〈0．05）,观察组下肢肿胀发生率明显低于对照（χ2=8．528,P〈0．01）。结论护理干预对预防重症产妇剖宫产术后下肢深静脉血栓成有积极意义。     

PICC置管中延迟撤除支撑导丝对颈内静脉导管异位复位成功率的影响

目的探讨经外周静脉置入中心静脉导管（PICC）时延迟撤离支撑导丝对颈内静脉导管异位复位成功率的影响。方法将2013年1月至2014年1月行PICC的316例患者随机分为对照组和观察组各158例。对照组在导管置入预测长度后撤离支撑导丝,再用超声探头探查颈静脉,确认导管无异位后修剪导管并连接正压接头,如发现导管异位立即在无菌条件下行复位;观察组在导管置入至预测长度后立即用超声探头探查颈静脉,如导管无异位再撤离支撑导丝,修剪导管并连接正压接头,如发现导管异位及时在支撑导丝作用下行复位。对比两组患者在置管过程中颈内静脉导管异位的发生率、复位成功率以及平均复位时间的差异。结果观察组发生导管异位30例,其中颈内静脉导管异位29例;对照组发生导管异位32例,其中颈内静脉导管异位27例。观察组颈内静脉导管异位发生率（18.35%）与对照组（17.09%）比较,差异无统计学意义（P〉0.05）;但复位成功率（96.55%,28/29）高于对照组（77.78%,21/27）,平均复位时间[（5.70±1.22）min]短于对照组[（8.90±2.53）min],差异均有统计学意义（χ2=4.51,t=6.10,P〈0.05）。结论在超声引导下应用赛丁格技术行PICC术中,导管送至预测长度后常规探查颈静脉,排除颈内静脉导管异位后撤除支撑导丝,有利于颈内静脉导管异位的复位。     

彩色多普勒超声在下肢深静脉血栓早期诊断中的应用价值

目的 探讨彩色多普勒超声诊断早期下肢深静脉血栓的应用价值.方法 选择2011年1月1日-2012年12月31日在该院彩色多普勒超声检查就诊患者396例,观察下肢静脉血栓形态、部位、回声及血流动力学特征,应用受试者曲线（ROC）评价其诊断效果.结果 下肢深静脉血栓36例,超声检出率9.09%.急性血栓占58.3%（21/36）,亚急性血栓占22.2%（8/36）,慢性血栓占19.4%（7/36）.急性期声像显示：血栓部位的管径显著增宽,血管内壁规则、清晰,呈现均匀低回声,血栓部位血流充盈缺损;亚急性期：静脉管径粗细不均匀,回声较急性期增强,血栓可呈强回声、等回声等,血管充盈缺损;慢性期：血管管径趋于正常或变细,血栓区呈中等或较高回声,有机化再通者可见彩色血流.ROC曲线下面积（AUC）为0.969,标准误为0.022,95%CI为0.926～1.000,灵敏度为94.4%,特异度为99.4%.结论 应用多普勒超声检查下肢深静脉血栓时,应结合回声、管腔变化、血流动力学等特征作出判断,该方法具有较高的灵敏度和特异度,值得临床应用推广.     

急性门静脉系统血栓形成临床诊治研究

目的 探讨急性门静脉系统血栓形成的临床特征,以提高对该病的认识.方法 对该院在2002年1月-2011年12月的10年间共收治的17例急性门静脉系统血栓形成患者的临床资料进行回顾分析,并结合文献进行复习.结果 17例患者均急性起病,主要症状为腹痛、腹胀、纳差.其中,单纯门静脉血栓形成4例（23.5%）,单纯肠系膜上静脉血栓形成6例（35.3%）,门静脉、肠系膜上静脉及脾静脉均有血栓形成7例（41.2%）.经肠系膜上动脉置管溶栓治疗5例,经外周静脉溶栓或抗凝治疗11例,肠切除术1例.17例患者治愈7例,好转6例,自动出院3例,死亡1例.结论 急性门静脉系统血栓形成临床上少见,但进展快,病情危重,早期溶栓治疗效果较好.临床医务人员要不断提高对该病的认识,早诊早治,减少误诊.     

Microvesicles and diabetic complications - novel mediators,potential biomarkers and therapeutic targets

Microvesicles （MVs）, also known as microparticles, are small membrane vesicles released from different cell types under different conditions. MVs have been detected in the circulation and in organs/tissues in various diseases, including diabetes. Patients with different types of diabetes and complications have different cellular MV patterns. Studies have shown that MVs may mediate vascular thrombosis, vascular inflammation, angiogenesis, and other pathological processes of the disease through their procoagulant, pro-inflammatory, pro-angiogenic, proteolytic, and other properties. Therefore, MVs contribute to the development of diabetic macrovascular and microvascular complications. In addition, clinical studies have indicated that changes in MV number and composition may reflect the pathophysiological conditions of disease, and therefore, may serve as potential biomarkers for diagnostic and prognostic use. Understanding MVs＇ involvement in the pathophysiological conditions may provide insight into disease mechanisms and would also be helpful for the development of novel therapeutic strategies in the future. Here, we review the latest publications from our group and other groups and focus on the involvement of MVs in diabetic complications.     

Preoperative Comorbidities as Potential Risk Factors for Venous Thromboembolism after Joint Arthroplasty: A Systematic Review and Meta-Analysis of Cohort and Case-Control Studies

The purpose of this study was to examine the effect of preoperative comorbidities on the risk of VTE after joint arthroplasty surgery. Of 2235 citations identified for screening, 16 studies reporting 7,395,847 patients were eligible. The results showed that patients with cardiovascular disease, previous VTE history, neurologic disease and high anesthetic ASA rating had significantly higher VTE risk than those with no such preexisting medical comorbidities after joint arthroplasty. The presence of respiratory disease, urinary and kidney disease, coronary artery disease, endocrine disease, cancer and malignant disease, hematological disease and comorbidities index did not increase the risk of VTE in our study. The data suggest that risk assessment of patients may further reduce the overall incidence of DVT and PE from VTE prophylaxis.